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感染性屈肌腱鞘的引流

PDF Evidence Consent
Updated Sep 2026
Illustration: 感染性屈肌腱鞘的引流

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

为何建议进行此手术

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 医生通过及时引流来治疗此感染，因为延误可能影响手指日后的活动功能。患者通常由其全科医生（GP）转诊至我们的诊所；如果理疗师建议您就诊，您仍需获得全科医生的转诊，方有资格享受 Medicare 报销。在评估时，我们会采集病史，检查您的手指，并在必要时安排影像学检查或检测。

此感染影响使手指肌腱滑动的组织隧道。它会导致肿胀、手指掌侧沿线的压痛，以及手指伸直时的疼痛。它通常继发于刺伤或划伤，有时伤口很小。单靠抗生素通常是不够的，因为脓液会积聚在该封闭隧道内。手术通过小切口冲洗清除感染，并结合抗生素治疗。快速行动可最大程度地保证肌腱恢复自由滑动，目标是缓解疼痛并保持手指活动。

术前

手术前七小时需停止进食和饮水。我们要求七小时而非六小时，以便在手术室排程提前时能让您提前手术。您的外科医生会告知您当天需跳过哪些常规药物，携带一份您正在服用的所有药物的书面清单会有所帮助。请安排事有人送您回家，并穿着宽松舒适的衣物。可能需要一些影像学检查来规划手术，例如X光、超声或MRI扫描。如果您有其他健康状况，手术当天之前可能还需要进行血液检查或与麻醉师进行会诊。

手术当天

您抵达医院的手术入院单元，在此办理入院手续并为手术室做准备。您将见到麻醉医生，他会评估您的健康状况并解答您的疑问。本手术在全身麻醉下进行。有时会追加区域神经阻滞以缓解术后疼痛；麻醉医生将在当天就此与您讨论。随后，您将被带入手术室进行手术。

您将在复苏区苏醒，护士会在麻醉消退期间监测您的状况。一旦您的生命体征稳定，根据手术类型和您的恢复情况，您将被送往病房或回家。部分患者需要短期住院，以便通过静脉输液继续使用抗生素。在您离开之前，我们会说明如何护理您的手部，并安排您的后续随访。

手术内容

手术旨在切开手指内受感染的组织隧道，并冲洗排出其中的脓液。外科医生会沿手指掌侧做一个锯齿状切口。如果您因受伤已有伤口，该伤口将被纳入此切口中。部分将肌腱固定在骨骼附近的细小组织带会被部分松解，以便外科医生能够触及肌腱及其周围的隧道。

随后，隧道会被反复用含有抗生素的液体冲洗，直到流出的液体变清。在此过程中，您的手指会被轻柔地弯曲和伸直，以便液体到达肌腱的各个部分。附着在肌腱上的任何受感染组织都会被清除。在某些情况下，隧道内会留置一根细软的导管，以便术后液体能持续通过导管冲洗，通常以缓慢且稳定的速率进行。导管会被仔细放置在隧道内，因为液体在皮下错误位置积聚可能会损害手指的血供。

切口用缝线关闭，大多数患者还会开始通过静脉输液接受抗生素治疗。抗生素的选择需匹配引起感染的病原体及其严重程度。部分患者需要在医院短期住院，以便继续进行静脉抗生素治疗。

整个治疗是一个组合：手术引流感染，抗生素清除残留病灶。您的外科医生会向您解释这些治疗中哪些适用于您，因为具体步骤取决于感染的扩散范围以及手术中发现的情况。

术后

您将在复苏区醒来，护士会密切观察您直至意识恢复。疼痛将通过药物控制，您的手部将包扎敷料和绷带。一旦您感觉可以活动，即可下床走动，但前24小时需有人陪同。医疗团队会告知您是当天出院还是住院一晚。敷料通常保留约10天；除非我们告知您，否则请勿提前拆除。我们将在复诊时为您更换或拆除敷料。

恢复

您的手指在最初几天和几周内会感到疼痛和肿胀。肿胀通常会蔓延至整个手指并延伸至手掌。将手垫高放在枕头上，即使在睡觉时也是如此，有助于减轻肿胀。简单的止痛药通常能随着病情好转而缓解不适。

您的手部将保持包扎状态约10天。我们在复诊时会更换或拆除敷料。此后，您的恢复重点将转向活动度训练。此手术后的手部治疗由 Extend Rehabilitation 的 Ruby Doolan 负责。Ruby 是一名手部治疗师：她将指导您的锻炼，并为您制作手指所需的任何支具。锻炼从轻柔开始，随着疼痛减轻而逐步增加强度。您需要在一天中多次轻微地弯曲和伸直手指。这有助于肌腱在愈合过程中在腱鞘内滑动。

在此手恢复期间，您可以使用另一只手完成家中大多数事务。请保持切口清洁干燥，并避免用力抓握、提重物或弄脏手部，直到我们告知您安全为止。当您的手部佩戴支具，或在紧急制动时无法快速抓握和反应，或者您正在服用强效止痛药时，请勿驾驶。我们关于上肢手术后驾驶的指南解释了您何时可以重新驾车。

即使治疗顺利，手指出现一定程度的僵硬也是预期内的，活动度的恢复可能需要时间。您的恢复时间表可能与他人不同；我们将与您的治疗师一起指导您度过这一过程。

可能出现的并发症

大多数患者恢复良好，但偶尔可能出现并发症。您的外科医生和医疗团队会密切监测您的状况，以便尽早发现任何问题。

这种感染可能导致的一个问题是手指血供突然下降。医生将此称为指动脉缺血（digital ischaemia）。这意味着手指未能获得足够的血液供应，因此其颜色可能比旁边的手指显得苍白、晦暗或更深。手指可能会感觉发冷、麻木或比之前更疼痛，且疼痛可能表现为深部搏动性疼痛，而非愈合中手指常见的酸痛感。手指也可能迅速肿胀或触感变硬。

这种情况不容拖延。如果您注意到上述任何变化，请立即联系诊所；如果是非工作时间或无法联系到任何人，请前往急诊科。告知医疗团队您观察到的症状及其开始时间。及时治疗能为手指恢复血供提供最佳机会。

如果您在家且体内留置有冲洗管，在致电时请提及任何新的颜色变化、发冷或疼痛加剧的情况。如果您不确定自己注意到的情况是否算作并发症，也请致电咨询。随时提问都是可以的。

某些变化值得在下次复查时提出，而非前往急诊科，例如正在缓慢消退的轻度肿胀，或可通过简单止痛药缓解的不适。您的医疗团队会在随访时告知您哪些变化需要电话沟通，哪些可以等到预约时再处理。

如果您想了解具体数据，本页的并发症表格列出了典型的发病率。

何时联系我们

如果您出现发热，伤口周围发红范围扩大，或切口分泌物增多，请致电我们。如果疼痛突然加剧，手指颜色改变，或手指无法弯曲或伸直，请致电我们。如果您出现小腿肿胀或呼吸困难，或手指看起来苍白、暗紫或发冷，请立即前往急诊。这些变化需要紧急评估。如果您不确定，请随时致电。

Reviewed by AI synthesis (v2) — pending human review · 19 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Anatomy & Pathophysiology

General Hand Architecture

  • The hand is composed of 19 bones, 17 articulations, and 19 muscles situated entirely within the hand [2].
  • The hand contains approximately the same number of tendons activated by the forearm muscles as it has intrinsic muscles [2].
  • The hand functions as an organ designed to obtain information and an organ of execution [2].
  • The hand moves within a large volume of space with the shoulder as the apex, allowing it to reach any part of the body fairly easily due to the mobility of the shoulder, elbow, and wrist [2].
  • Distal to the elbow, the wrist and forearm function as a single physiological unit that places the hand in a position for grasping [2].
  • The open hand forms a balanced graceful oval in its longitudinal axis when fingers are extended and in contact [2].
  • The proximal carpometacarpal half of the hand is flattened, presenting two faces with unique anatomical and functional significance [2].
  • The posterior or dorsal aspect of the hand is convex, while the anterior, palmar or volar aspect is concave [2].
  • The distal half of the hand is separated into five digits that flex toward the palm [2].
  • The digits converge in closing by flexing and adducting, and diverge in opening by extending and abducting [2].
  • The thumb has a more proximal and lateral position than the four fingers, allowing movement inward and outward from the palm [2].
  • The four fingers are the distal extension of the carpometacarpal part of the hand [2].
  • The hinges for finger movement are located at the thenar crease and at the transverse distal palmar crease, not at the bases of the digits [2].
  • When fingers are extended and separated, their tips lie on the circumference of a circle whose center is the head of the third metacarpal [2].
  • The web space of the thumb is the largest and deepest among the digital web spaces [2].

Cutaneous Anatomy

  • Functional cutaneous units in the hand are similar to those described in the face [3].
  • One dorsal cutaneous unit extends from the wrist to the proximal interphalangeal joints of the fingers and the interphalangeal joint of the thumb [3].
  • The dorsal covering of the interphalangeal articulations forms a unique cutaneous unit characterized by a considerable excess of skin when digits are in extension [3].
  • The fine tight skin of the dorsal aspect of the middle phalanx forms a distinct cutaneous unit [3].
  • The dorsal integument of the distal phalanx is distinct due to the nail bed with its matrix [3].
  • The palm forms a cutaneous unit extending from the distal transverse crease of the wrist up to the transverse crease at the base of the digits [3].
  • The palmar integument is subdivided into two separate zones by the oppositional crease of the thumb, which constitutes the oblique axis of the hand [3].
  • The skin of the radial portion of the palm covers the thenar eminence and external part of the palm, is relatively well vascularized, and is the mobile portion [3].
  • The skin of the ulnar and distal portion covers the hypothenar eminence where skin has poor mobility [3].
  • The distal part of the palm beyond the transverse distal palmar crease acts as a true hinge at the level of the metacarpophalangeal articulations [3].
  • The central triangular part of the palm has fixed and poorly vascularized skin that covers almost directly the superficial palmar aponeurosis, which inserts into it [3].
  • The integument of the palmar face of the digits is subdivided into phalangeal units separated by digital flexion folds [3].
  • There are three digital flexion folds for the fingers and two for the thumb [3].
  • When a digit is completely flexed, the integument of adjacent phalanges comes into contact in the zones of the flexion creases, establishing areas of cutaneous contact in the form of a diamond [3].
  • The sides of the diamond-shaped cutaneous contact zones do not undergo variations in length during flexion and extension movements [3].
  • Incisions made along the lines of the diamond-shaped cutaneous contact zones present a minimal chance of retraction [3].
  • The web spaces are formed from the union of two nonsymmetrical cutaneous surfaces [3].
  • The dorsal slope of the web space has a gradual incline and its supple skin is not adherent to the subjacent region [3].
  • The palmar surface of the web space is flat and precipitously interrupted, with skin densely adherent to the commissural skeleton [3].
  • The commissural skeleton is formed by the interdigital palmar (natatory) ligament between the fingers and by the distal transverse ligament at the level of the thumb web [3].
  • The distal transverse ligament at the level of the thumb web is by far the deepest and the most mobile [3].

Intrinsic Musculature

  • There are seven interosseous muscles in the hand, consisting of four dorsal and three volar muscles [4].
  • The dorsal interossei are abductors [4].
  • The anatomic axis of the hand coincides with the axis of the third metacarpal [4].
  • The dorsal interossei lie to the radial side of the index and middle fingers and the ulnar side of the middle and ring fingers [4].
  • The little finger is abducted by the abductor digiti quinti [4].
  • The volar interossei are adductors [4].
  • The volar interossei lie to the ulnar side of the index finger and the radial side of the ring and little fingers [4].
  • The middle finger has two dorsal interossei (abductors) and no volar interossei (adductors) because the central axis of the hand lies within it [4].
  • Each dorsal interosseous muscle, with the exception of the third, has two muscle heads [4].
  • The superficial head of the dorsal interosseous muscles arises most dorsally from the shaft of the contiguous metacarpals [4].
  • The superficial head is inserted deeply by a medial tendon onto the lateral tubercle of the base of the proximal phalanx [4].
  • The superficial head abducts and weakly flexes the proximal phalanx [4].
  • The superficial head has no direct effect on the middle or distal phalanges [4].
  • The deep head of each dorsal interosseous muscle forms a lateral tendon, or lateral band, at the level of the MP joint [4].
  • The deep head flexes and weakly abducts the proximal phalanx while extending the middle and distal phalanges [4].
  • At the level of the middle of the proximal phalanx, transverse fibers arch dorsally from each lateral band to join each other over the dorsum of the finger [4].
  • These transverse fibers flex the proximal phalanx [4].
  • More distally, oblique fibers (spiral fibers) from the lateral bands sweep over the distal third of the proximal phalanx to insert onto the lateral tubercles at the base of the middle phalanx [4].
  • The oblique fibers extend the middle phalanx at the PIP joint [4].
  • The lateral bands are joined by the lateral slips of the extensor tendon to form the conjoined lateral band [4].
  • The two conjoined lateral bands to each finger unite at the distal third of the middle phalanx to form the terminal tendon [4].
  • The terminal tendon inserts at the base of the distal phalanx to extend it [4].
  • The flexor digiti quinti brevis is structurally and functionally similar to the deep head of the dorsal interossei [4].
  • The flexor digiti quinti brevis forms the ulnar lateral band of the little finger [4].
  • The three volar interossei arise from adjacent surfaces of contiguous metacarpal shafts [4].
  • Each volar interosseous muscle has only one muscle head [4].
  • None of the volar interossei insert onto the proximal phalanx [4].
  • The volar interossei form the ulnar lateral band of the index finger and the radial lateral band of the ring and little fingers [4].
  • The volar interossei send oblique or spiral fibers that insert onto the base of the middle phalanx at its lateral tubercle [4].
  • The abductor digiti quinti and flexor digiti quinti brevis are similar in both structure and function to the superficial and deep heads of the dorsal interossei, respectively [4].
  • The abductor digiti quinti and flexor digiti quinti brevis arise from the fifth metacarpal [4].
  • The abductor digiti quinti inserts onto the ulnar lateral tubercle at the base of the proximal phalanx of the little finger [4].
  • The flexor digiti quinti forms the ulnar lateral band [4].
  • The opponens digiti quinti lies deepest among the hypothenar muscles [4].
  • The opponens digiti quinti arises from the pisohamate ligament and the hook of the hamate [4].
  • The opponens digiti quinti inserts onto the ulnar side of the diaphysis of the fifth metacarpal [4].
  • The opponens digiti quinti flexes and supinates the fifth metacarpal [4].

Metacarpal and Arch Anatomy

  • The metacarpal arch is endowed with a great deal of adaptability because of the mobility of the peripheral metacarpals [7].
  • The peripheral metacarpals form the sides of the cup or the palmar gutter and can deepen the concavity as they approach each other [7].
  • The peripheral metacarpals are attached to the fixed element, which is the middle metacarpals [7].
  • The thumb metacarpal is independent and articulates with the trapezium [7].
  • The middle metacarpals are united to the carpus by the intrinsic interlocking encasement of the bones themselves [7].
  • The index metacarpal is the most firmly fixed [7].
  • The ring metacarpal is a transitional element to the fifth metacarpal and has about 10 degrees of mobility in flexion and extension [7].
  • The fifth metacarpal is semi-independent and articulates with the hamate [7].
  • The fifth metacarpal is restrained on its radial side by its articulation with the base of the fourth metacarpal [7].
  • The fifth metacarpal has a range of flexion–extension of approximately 20 degrees [7].
  • The second to fifth metacarpals are all bound together by various fibrous structures [7].
  • The most distal fibrous structure binding the second to fifth metacarpals is the deep transverse intermetacarpal ligament [7].
  • The deep transverse intermetacarpal ligament is better named the interglenoid ligament [7].
  • The interglenoid ligament ties together the anterior “glenoid ligaments” of the metacarpophalangeal articulations, known as the “volar plates” [7].
  • The longitudinal arches are composed of a fixed portion, the carpometacarpal, and a mobile portion, the digits [7].
  • There is a longitudinal arch for every ray [7].
  • The longitudinal arches diverge distally according to their different obliquities, with the thumb ray being the most divergent [7].
  • The keystones of the longitudinal arches are the metacarpophalangeal articulations [7].
  • The thick anterior glenoid capsules, known as volar plates, prevent hyperextension at the metacarpophalangeal articulations [7].
  • The volar plates are interconnected by the transverse interglenoid ligament [7].
  • The stability of the metacarpophalangeal joints is essential to the support of the longitudinal arch as well as of the transverse metacarpal arch [7].
  • The thumb ray has considerable mobility and independence [7].
  • The fifth ray has much less mobility and independence than the thumb [7].
  • The index ray has a certain degree of independence at the phalangeal level, owing to the arrangement of its flexor and extensor muscles, but not at the metacarpal level [7].

Vascular Anatomy

  • The arteries of the thumb vary in both size and number [8].
  • The layout of the thumb arteries is the result of innumerable variations regarding origin, transit, connections, and size [8].
  • The most common variations of the palmar arteries can be schematized by dividing the thumb into three segments defined by the metacarpophalangeal and interphalangeal flexion creases [8].
  • In the classical layout, the “princeps pollicis” artery, the terminal branch of the radial artery, crosses the first intermetacarpal space [8].
  • The “princeps pollicis” artery runs along the ulnar side of the first metacarpal bone and along the volar surface of the adductor muscle [8].
  • The “princeps pollicis” artery emerges onto the subcutaneous palmar tissue at the level of the cutaneous flexion crease of the metacarpophalangeal joint [8].
  • At the metacarpophalangeal joint level, the “princeps pollicis” artery divides into two terminal rami, namely the collateral palmar arteries of the thumb [8].
  • The collateral palmar arteries of the thumb run along the digital tunnel symmetrically and are of equal caliber [8].
  • The collateral palmar arteries head distally to finally unite in the pulp arcade [8].
  • During their transit in the digital tunnel, the collateral palmar arteries break off into numerous collateral branches, either cutaneous, articular, or osseous [8].
  • An arcade located deep in the flexor tendon joins together the two arteries at the level of the distal metaphysis of the first phalanx [8].
  • Vessels originating from the subtendinous arcade enter the “vincula” and irrigate the flexor tendon [8].
  • Only 15% of anatomical dissections fall into the category of the classical description of the palmar arteries of the thumb [8].
  • In the first segment of the thumb (between the opposition crease and the metacarpophalangeal flexion crease), it is rare to find arteries of surgical interest on the volar surface [8].
  • The artery in the first segment of the thumb is located deeply and is more easily accessible from the dorsal surface [8].
  • In the second segment of the thumb, the two arteries run alongside the flexor tendon and behind the collateral nerves [8].
  • In the second segment of the thumb, the main artery is the ulnar collateral artery [8].
  • The subtendinous anastomosis situated at the level of the neck of the first phalanx acts as a “moderator” between the two arteries in the second segment [8].
  • In cases where the palmar ulnar collateral artery is absent, the dorsal artery takes its place by means of a branch through the subtendinous arcade [8].
  • In the third segment (pulp segment) of the thumb, the two arteries are of similar size and run through the thick fatty subcutaneous padding [8].
  • In the pulp segment, the arteries cross over and convert into the ends of the digital nerves at the level of the median axis [8].
  • The posterior area of the thumb is vascularized by two arteries which originate from the palmar arteries (princeps, commissural, or anastomoses of the superficial arcade) at the level of the first metacarpal [8].
  • These dorsal arteries run laterally along the metacarpophalangeal joint and continue obliquely from volar to dorsal [8].
  • The dorsal arteries head in a distal direction remaining on the side of the two distal phalanges [8].
  • At the level of the neck of the first phalanx, an anastomosis can be found which originates from the palmar arteries for the dorsal supply [8].
  • The ulnar dorso-collateral artery generally stems from the “princeps pollicis” onto the medial border of the neck of the first metacarpal [8].
  • The ulnar dorso-collateral artery heads distally remaining on the lateral surface of the finger [8].

Surgical Approach Considerations

  • Distal palmar incisions are transverse as a rule [9].
  • In the proximal palm, incisions tend to be more longitudinal, with the distal end curving radially and paralleling the closest major skin crease [9].
  • An incision of any desired length can be made across the palm, provided that the underlying digital nerves and other vital structures are protected [9].
  • After the skin and underlying fat have been incised, the fat is dissected from the palmar fascia and is carried with the skin flaps [9].
  • Most of the vital structures in the palm are deep to the palmar fascia [9].
  • In the distal palm, structures lying between the metacarpal heads are not protected by the palmar fascia [9].
  • The superficial volar neurovascular arch should be protected when deeper exposure is required [9].
  • Incisions in the more proximal palm should parallel the thenar crease [9].
  • When extended proximal to the wrist, incisions should not cross the flexor wrist creases at a right angle [9].
  • The most important structure in the thenar area is the recurrent branch (motor) of the median nerve [9].
  • Anatomic studies have shown that there is no single longitudinal incision in the proximal palm that completely avoids the palmar cutaneous branches of the median and ulnar nerves [9].
  • The volar

Investigations

  • Clinical evaluation of the injured or dysfunctional hand and wrist requires combining patient history with a careful physical examination to pinpoint or narrow the scope of possible pathologic processes [1].
  • Diagnostic tests such as imaging and serum laboratory studies are useful in determining pathology but can be expensive, time consuming, and often nonspecific [1].
  • A careful physical examination is essential to direct care and future testing if indicated [1].
  • An 8-MHz Doppler tone assessment may be used to identify superficially displaced neurovascular bundles when Dupuytren cords lie beneath soft fleshy prominences [11].
  • False-negatives are possible with 8-MHz Doppler tone assessment for identifying neurovascular bundles [11].
  • MRI is probably most useful in identifying additional pathology such as flexor tendon bowstringing [11].
  • MRI may be helpful in providing a quantitative noninvasive measure of cellularity of affected areas, which is an index of biologic activity [11].
  • The potential of MRI as a staging tool based on cellularity measurement has not been investigated yet on a large scale [11].

References

[1] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Evaluation and Clinical Examination: Current Concepts.

[2] Exam Of The Hand Wrist 2Ed. INTRODUCTION.

[3] Exam Of The Hand Wrist 2Ed. Functional cutaneous units.

[4] Green S Operative Hand Surgery. Interosseous and Hypothenar Muscles.

[7] Exam Of The Hand Wrist 2Ed. The arches of the hand > The metacarpal arch.

[8] Exam Of The Hand Wrist 2Ed. Techniques of investigation of the arterial supply by J P Melki > Vascularization of the thumb > Palmar aspect.

[9] Campbell S Operative Orthopaedics 4 Volume Set. RESULTS OF SUTURE OF THE SCIATIC NERVE > PALMAR INCISIONS.

[11] Dupuytren S Disease And Related Hyperproliferative Disorders. 54. The Future of Dupuytren’s Research and Treatment > 54.4 Mechanical Measurements and Procedures > 54.4.4 Imaging.

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